News Archive

"The decision turns on two issues of interest to ERISA practitioners: whether the policy qualified as an ERISA-governed employee welfare benefit plan, and, after concluding that it did not, how Texas state law resolves a beneficiary dispute where the decedent signed a binding informal settlement agreement in pending divorce proceedings but died before the divorce decree was entered." [Principal Life Ins. Co. v. Jones, No. 25-0221 (S.D. Tex. May 27, 2026)]  MORE >>

"[T]he Sixth Circuit rejected the opposing approach of other Circuits, which suggested that post-payment reimbursement disputes fall outside ERISA's enforcement provisions.... In distinguishing those cases, the Sixth Circuit pointed out that those decisions involved situations where the insureds challenged their insurers' reimbursement rights based on a state statute, whereas Mr. Patterson asserted that 'his entitlement to benefits originate[d] with the 'terms and conditions' of his plan -- not some freestanding source of state law.' " [Patterson v. UnitedHealth Group, Inc., No. 25-3175 (6th Cir. Dec. 2, 2025)]  MORE >>

"This decision reinforces the broad scope of ERISA preemption for self-insured health plans. While the Supreme Court's Rutledge decision narrowed preemption in some ways, this ruling illustrates that state laws directly regulating the design and structure of a self-insured plan's benefits, such as AWP laws, are still likely to be preempted." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"That strategy of recasting claims for benefits under an ERISA plan as claims under state law ... runs headlong into one of ERISA's most potent defenses: the preemption defense. This defense is particularly important for companies that work in and near the employee benefits space and find themselves targeted with litigation arising from their work.... For example, where an employee accuses an insurer or technology platform of misrepresenting the availability of a particular benefit and seeks damages arising from the misrepresentation, that claim will generally be preempted."  MORE >>

"[This case] gives self-funded ERISA plan sponsors in the Sixth Circuit helpful guidance on where to draw the line between the permitted state PBM regulations described in Rutledge and ERISA-protected plan design. The Sixth Circuit made clear that a state may not require a self-funded ERISA health plan to open its pharmacy network to any willing pharmacy if doing so takes away the employer's ability to decide which pharmacies will participate." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"McKee confirms that there are limits to state PBM regulation. States may regulate PBM reimbursement rates and other costs, but when they: Require inclusion of all willing pharmacies in networks, or Prohibit differential copays and other steering mechanisms within networks, they are dictating ERISA plan structure and administration and risk preemption, at least as applied to self‑funded plans." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"McKee confirms that there are limits to state PBM regulation. States may regulate PBM reimbursement rates and other costs, but when they: Require inclusion of all willing pharmacies in networks, or Prohibit differential copays and other steering mechanisms within networks, they are dictating ERISA plan structure and administration and risk preemption, at least as applied to self‑funded plans." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"The court examined separately the 'any-willing-provider' provisions and the 'incentive provisions' of Tennessee's PBM laws. The 'any-willing-provider' provisions required plans to admit into their networks any pharmacy willing to accept the terms and conditions of the plans. The court found that these laws were preempted by ERISA because they mandated a specific benefit structure, governed a central matter of plan administration, and disrupted nationally uniform plan administration." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"A federal appeals court last week ruled against Tennessee in a case over whether the state could require PBMs to partner with any pharmacy that's willing to accept their terms and conditions. That followed rulings against PBM laws in Iowa and Oklahoma that courts found were preempted by the federal ERISA law."  MORE >>

"The Sixth Circuit determined that the Tennessee any-willing-provider provision impermissibly restricted self-funded ERISA plans because by removing the plan sponsor's choice of pharmacy network providers, the law effectively made network decisions, which were 'a central matter of plan administration,' and required plans to be designed in a particular way.... The incentive and disincentive provisions were also held to be impermissible restrictions on self-funded ERISA plans by dictating key plan design and structure requirements[.]" [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

17 pages. "This guidance paper deals specifically with questions about preemption of state PBM laws under [ERISA] ... [It] provides some guidance related to ERISA preemption by undertaking an analysis of the different types of state PBM laws and considering how appellate courts have applied the reasoning in Rutledge to those laws."  MORE >>

"[T]he court held that both categories of PBM laws had an impermissible 'connection with' ERISA plans under 29 U.S.C. Section 1144(a). Applying the framework from Rutledge and Gobeille ... the court identified three independent grounds for preemption: the laws [1] required providers to structure benefit plans in a particular way, [2] governed a central matter of plan administration, and [3] interfered with nationally uniform plan administration." [McKee Foods Corporation v. BFP Inc., No. 25-5416 (6th Cir. Apr. 7, 2026)]  MORE >>

"Plaintiffs contended that the Garmon doctrine [1] only applies to state law claims, and [2] only applies to federal claims 'within the jurisdiction of the NLRB,' i.e., not ERISA claims. The Sixth Circuit rejected both arguments. The court emphasized that the doctrine applies to all federal claims arising from activities arguably subject to the NLRA, including ERISA claims.... According to the Sixth Circuit, 'Plaintiffs' ERISA claims can succeed 'only if' Defendants' 'conduct violates the NLRA,' rendering the NLRA issues 'anything but collateral.' " [Rieth-Riley Construction Co., Inc. v. Trustees of the Operating Engineers' Local 324 Fringe Benefit Funds, No. 25-1823 (6th Cir. Apr. 3, 2026)]  MORE >>

"[T]he federal government has moved to dismiss a suit from a trio of former Morgan Stanley financial advisers that had filed suit regarding a [DOL] advisory opinion that said the bank's deferred compensation plans likely aren't protected under ERISA."  [Sheresky v. U.S., No. 25-8935 (S.D.N.Y. complaint filed Oct. 28, 2025; defendant's motion to dismiss filed Mar. 11, 2026)]  MORE >>

"PMCA's arguments in favor of ERISA preemption of the fiduciary standards provision for self-funded employer plans center around three main points: [1] It makes an impermissible reference to ERISA plans because it specifically references 'self-insured employer plans'; p2[ It regulates in a field already fully occupied by federal standards ... and [3] It requires plan sponsors to design or structure their plan in a particular way[.]" [Pharmaceutical Care Management Association v. Bonta, No. 26-0012 (C.D. Calif. complaint filed Jan. 2, 2026)]  MORE >>

"The plaintiff is challenging the Iowa law requiring that, among other provisions, 'any willing pharmacy' be included in a prescription drug plan's provider network, including self-insured prescription drug plans governed by ERISA. In October, a federal judge blocked enforcement of several portions of the law, citing potential conflict with ERISA. In its brief, ERIC argued that ERISA preempts Iowa's law because that law directly interferes with prescription-drug benefit plan design and administration [.]" [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025; on appeal to 8th Cir. No. 25-2494)]  MORE >>

"The ERISA Industry Committee (ERIC) and allied organizations filed an amicus brief in the U.S. Court of Appeals for the Eighth Circuit ... The lower court had ruled that certain provisions of a new Iowa state law -- Senate File 383 -- regulating [PBMs] are preempted by [ERISA], but that other provisions of the law were not preempted. In its brief with the Eighth Circuit, ERIC asked the court to affirm the lower court's decision in part and to reverse it in part to provide that all of Senate File 383 is preempted by ERISA." [Iowa Assoc. of Bus. and Ind. v. Ommen, No. 25-0211 (S.D. Iowa Jul. 21, 2025; on appeal to 8th Cir. No. 25-2494)]   MORE >>

"Initially, the Court declined to certify the class on adequacy and commonality grounds. On a renewed motion, however, the Court found there was evidence that enough individuals had actually paid balance bills to satisfy numerosity and that the key questions in the case predominated over individual differences, making class certification appropriate." [L.D. v. United Behavioral Health, No. 20-2254 (N.D. Cal. Oct. 3, 2025)]  MORE >>

"Judge Glenn Suddaby of the U.S. District Court for the Northern District of New York in Syracuse declined a dismissal motion for governmental immunity by the Nation's hospitality and gaming company ... Suddaby's ruling on [ERISA] lawsuit, brought in December 2024 by three former police officers, said he wouldn't dismiss the case against the company's benefits plan and investment committee, because the retirement plan also covers non-government casino employees who represent most of the plan participants." [Jones v. Turning Stone Enterprises LLC, No. 24-1596 (N.D.N.Y. Dec. 9, 2025)]  MORE >>

"The panel's brief decision underscores that the Court's 2024 decision in Bristol Holdings applies broadly to state-law causes of action arising from pre-service verification-of-benefits and authorization communications, even where a provider also pleads an alternative ERISA benefits claim pursuant to an assignment of benefits from the member.  ... [T]he disposition is a clear, persuasive affirmation of Bristol's reach." [Dedicato Treatment Center, Inc. v. Aetna Life Ins. Co., No. 26-6487 (9th Cir. Nov. 24, 2025; unpub.)]  MORE >>

"This decision reinforces the Ninth Circuit's now-settled view post-Bristol: state-law misrepresentation and estoppel theories aimed at securing ERISA plan benefits are preempted, particularly when based on preauthorization or verification calls. Providers seeking payment disputes must proceed, if at all, under ERISA's civil-enforcement framework -- not state-law theories of reliance or oral promises." [Healthcare Ally Mgmt. of Calif., LLC v. United Healthcare Services, Inc., No. 24-5178 (9th Cir. Dec. 4, 2025; unpub.)]  MORE >>

"The panel's brief decision underscores that the Court's 2024 decision in Bristol Holdings (discussed here) applies broadly to state-law causes of action arising from pre-service verification-of-benefits and authorization communications, even where a provider also pleads an alternative ERISA benefits claim pursuant to an assignment of benefits from the member." [Dedicato Treatment Center, Inc. v. Aetna Life Ins. Co., No. 26-6487 (9th Cir. Nov. 24, 2025; unpub.)]  MORE >>

"Although the plaintiff pleaded only state-law claims -- including fraud, negligent misrepresentation, conversion, unjust enrichment, and civil conspiracy -- the court held that ERISA's 'extraordinary pre-emptive power' converted those claims into federal claims under ERISA Section 502(a). Because the plaintiff already had a parallel ERISA action pending over the same conduct, the court allowed dismissal of the duplicative suit." [Patterson v. UnitedHealth Group, Inc., No. 25-3175 (6th Cir. Dec. 2, 2025)]  MORE >>

"The plans argued that since Rule 128 places a direct obligation on ERISA-governed plans in the form of reporting and dispensing fee requirements, ERISA preempts it. ... The court noted that the rule applies to all plans, not just plans that fall under ERISA.... One critic of the decision pointed out that Rule 128 expressly refers to self-funded plans and establishes reporting requirements similar to the PBM rule that the Supreme Court found to be preempted by ERISA in Gobeille[.]" [Central States, Southeast and Southwest Areas Health and Welfare Fund v. McClain, No. 25-3938 (N.D. Ill. Sep. 2, 2025)]  MORE >>

"Despite Rule 128's express reference to self-funded plans and imposition of a reporting requirement similar to one the Supreme Court found to be preempted by ERISA in Gobeille, the district court found that neither the reporting requirement nor the dispensing fee requirement were preempted by ERISA." [Central States, Southeast and Southwest Areas Health and Welfare Fund v. McClain, No. 25-3938 (N.D. Ill. Sep. 2, 2025)]  MORE >>